Health

After Attacks, Seattle Rethinks How To Treat Mentally Ill

by Martin Kaste
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September 18, 2013 — 1:43 PM

The Navy Yard massacre may renew concerns over the potential dangers of mentally ill people who don't get treatment. That issue is especially hot right now in Seattle, where the mayor has called untreated mental illness an "emergency."

Unstable In Seattle

Seattle's Pioneer Square is an uneasy mix of art galleries and skid road; it's gelato over here, and heroin over there. And then there's mental illness.

"It's scary," says James Nevin. He says he sees it every day. "There's one guy, man, I walk by him all the time and this guy says the most heinous things I've ever heard ... and then I'll see him a few hours later and he's got the sweetest personality and disposition you could ever possibly have."

Unstable people have made downtown Seattle jittery lately — for good reason. In August, a man with a history of mental illness shot and wounded a bus driver, then died in a chaotic shootout with police. And just last Friday night, a self-identified schizophrenic attacked a couple with a knife, wounding the woman and killing her boyfriend.

"This isn't the first time this summer we've seen someone with a mental health issue," Seattle Mayor Mike McGinn says.

On Monday, even as news was coming in about the massacre across the country, McGinn acknowledged the growing nervousness.

"I do not want to stigmatize people with mental health issues," he says. "Very, very few are violent. But when someone is violent, we have to have the ability to identify that, provide services and potentially isolate them, so that they cannot harm themselves or others."

'Preventable Tragedies'

Washington state ranks low in its per capita supply of psychiatric hospital beds and there have been cuts to outpatient mental health care, too. At the same time, lawmakers have made it easier to get someone committed — at least temporarily.

Amnon Shoenfeld, director of mental health for Seattle's King County, says if someone has a psychotic episode on the streets, the cops will pick him up. The problem is, with the shortage of psychiatric beds, that person often ends up parked in an emergency room.

"You'll have somebody who's being held for involuntary commitment, probably in restraints, on a gurney next to someone who's come in to the emergency room probably for a broken foot," Shoenfeld says.

The situation in Seattle is just the latest chapter in a national story that started 50 years ago, when America began de-institutionalizing the mentally ill.

The Treatment Advocacy Center tracks what it sees as the human cost of this policy, in an online database of "preventable tragedies."

"If you look at the 12 worst, the deadliest shootings, in our history, six of them occurred in the last decade," says Doris Fuller, head of the organization. "And of those, Virginia Tech, Sandy Hook, Aurora appear easily associated with mental illness."

Fuller argues that de-institionalization went too far, that it's time to fund more hospital beds, more treatment — and, when justified, to compel that treatment.

The argument isn't without controversy; there's a fear it could lead back to the bad old days of warehoused patients, forced by the government to take psychotropic drugs. But right now, in places like Seattle's Pioneer Square, there's a growing sense that it's time for the pendulum to swing back a bit in that direction.

The Navy Yard shootings are renewing concerns about violence and mental illness. NPR's Martin Kaste says that issue is especially hot right now in Seattle, where the mayor has called untreated mental illness an emergency.

MARTIN KASTE, BYLINE: Seattle's Pioneer Square is an uneasy mix of art galleries and skid row; it's gelato over here, heroin over there. And then you have the mental illness.

JAMES NEVIN: It's scary.

KASTE: James Nevin sees it every day.

NEVIN: And there's one guy, man, I walk by him all the time. And this guy says the most heinous things I've ever heard. And then I'll see him a few hours later and he's got the sweetest personality and disposition you could ever possibly have.

KASTE: Unstable people have made downtown Seattle a jittery place lately. In August, a man with a history of mental illness shot and wounded a bus driver, then died in a chaotic shootout with the police. And just last Friday night, a self-identified schizophrenic attacked a couple with a knife, wounding the woman and killing her boyfriend. It happened just steps from where Nevin is standing now.

NEVIN: It's an unpredictability element that these mental patients have, man, that just kind of adds to this atmosphere.

KASTE: The violent crime rate in Seattle is no worse than similar-sized cities and it's half the rate of D.C. But these incidents have dredged up memories of other mentally-ill murderers. There's the guy who shot up Cafe Racer last year, and the homeless man who killed two strangers with a hatchet in 2010.

People worry that Seattle has a problem and Mayor Mike McGinn, fighting for re-election, says he wants to fix it.

MAYOR MIKE MCGINN: I do not want to stigmatize people with mental health issues. Very, very few are violent. But when someone is violent, we have to have the ability to identify that, provide services, and potentially isolate them so that they cannot harm themselves or others.

KASTE: Washington State ranks low in its per capita supply of psychiatric hospital beds. And there have been cuts to out-patient mental health care, too. At the same time, lawmakers have made it easier to get someone committed, at least temporarily. Amnon Shoenfeld, director of mental health for Seattle's King County, says that means the mentally ill often end up parked in emergency rooms.

AMNON SHOENFELD: You'll have somebody who's being held for involuntary commitment, probably in restraints, on a gurney next to someone who's come in to the emergency room for a broken foot.

KASTE: The situation in Seattle is just the latest chapter in a national story that started 50 years ago, when America began de-institutionalizing the mentally ill. Doris Fuller is the head of an organization called the Treatment Advocacy Center.

DORIS FULLER: Psychiatric beds, which Mayor McGinn is talking about in part, have dropped nationwide about 95 percent.

KASTE: Fuller's group tracks what it sees as the human cost of this policy, in an online database it calls Preventable Tragedies.

FULLER: If you look at the 12 worst, the deadliest shootings in our history, six of them occurred in the last decade. And of those, Virginia Tech, Sandy Hook, Aurora, appear easily associated with mental illness.

KASTE: Fuller argues that it's time to fund more psychiatric beds and more treatment and, in some cases, to compel that treatment. This isn't without controversy; there's a fear it could lead back to the bad old days of warehoused patients, who are forced by the government to take psychotropic drugs. But right now, in places like Pioneer Square, there is a sense that it may be time for the pendulum to swing back a little in that direction.